tbuckley/cabot-search huggingface dataset:
Association of pain catastrophizing longitudinally with pain severity and interference in patients with chronic pain and cancer: A CHOIR study.
Authors: Desiree Rachel Azizoddin, Jenna Wilson, Sean Mackey, Kelsey Mikayla Flowers, Beth Darnall, Robert Edwards, Kristin L. Schreiber
Journal: Journal of Clinical Oncology (2022)

213 Background: Understanding how psychosocial factors change during cancer and affect chronic pain outcomes may help identify potential interventional targets. This longitudinal cohort study of cancer patients investigated the relationship between changes in psychosocial factors and worsened pain severity and interference over time using the Collaborative Health Outcomes Information Registry (CHOIR) dataset. Methods: Data from patients with cancer and chronic pain (n = 316) treated at a tertiary pain clinic were prospectively collected. At their initial visit (baseline; Time 1), patients provided demographic and clinical information, and completed validated psychosocial and pain assessments. Psychosocial and pain assessments were repeated at Time 2, on average 4.9 months later. Change scores (Time 2-Time 1) were computed for psychosocial and pain variables. Multivariable hierarchical linear regressions assessed the associations between changes in psychosocial factors with changes in pain outcomes over time. Results: Participants had an average age of 59, were 61% female, and 69% White. Overall, a decrease in pain severity ( p≤.001), but not pain interference, was observed among the group from T1 to T2. Increased pain catastrophizing was significantly associated with increased pain severity over time (b= 0.24, p≤.001). Similarly, increased pain catastrophizing (b= 0.21, p≤.001) and increased depression (b= 0.20, p≤.003) were significantly associated with increased pain interference over time. Demographic and clinical characteristics were not significantly related to changes in pain outcomes. Conclusions: Increased catastrophizing was uniquely associated with increased chronic pain severity and interference. Future interventional studies investigating the utility of nonpharmacological approaches that address psychological processes, like catastrophizing, for patients with cancer and chronic pain are needed.
Decreasing time to chemotherapy administration in patients with hematologic malignancy on the inpatient APP service.
Authors: Katlin Fendler, Gloria Espinosa, Judith Alberto, Dianne Morales, Megan Miraglia, Adam F Binder
Journal: Journal of Clinical Oncology (2022)

260 Background: Patients with hematologic malignancies are often electively admitted for chemotherapy. Through an informal survey, patients expressed the desire to start chemotherapy within 4 hours of arriving to the hospital. Not only is this an important process to address to improve patient satisfaction but also to decrease hospital length of stay. As a result, we developed a quality improvement initiative to improve our median time to chemotherapy administration from 6 hours 41 minutes to a median of 3 hours over a 6 month period from 03/01/22 to 09/01/22. Methods: Baseline data was collected, from 9/1/2021 to 12/31/2021, on all Hematologic Malignancy patients’ electively admitted for chemotherapy at Thomas Jefferson University Hospital. Benchmarks in our steps to initiate chemotherapy include time from admission to placing initiate to treat order, time from initiate order to nurse releasing chemotherapy, time from nurse releasing to pharmacy review of chemotherapy order, and time from pharmacy review to administration of chemotherapy. Data was collected and analyzed. Potential interventions were discussed and prioritized. At the time of this abstract, 2 full PDSA cycles have been completed. Results: From 9/1/2021 to 12/31/2021, admissions for 40 patients with a diagnosis of a Hematologic Malignancy were evaluated. Median time from admission to administration of chemotherapy was 6 hours 41 minutes. The first intervention implemented on 03/01/22 involved a care team (i.e. chemotherapy pharmacists and nurse, bedside nurse) message via our electronic medical record communication system to notify them when the initiate to treat order was placed. PDSA 2 implemented on 05/04/22, involved releasing chemotherapy prior to confirmation of line placement. PDSA 3 is ongoing and focuses on pre-admission planning. See Table for detailed results of each PDSA. Conclusions: Increasing communication between key players in the chemotherapy process decreased time to chemotherapy administration by 2 hours. Feedback has been positive from all key players with no clear negative unintended consequences. Some of this improvement seen was due to an increased awareness of the provider to initiate treatment sooner. Ongoing interventions are currently underway with the hopes that these help achieve our goal of initiating chemotherapy in a median time of 3 hours.[Table: see text]
A community hospital’s approach towards same-day discharge after minimally invasive hysterectomies during the COVID-19 pandemic.
Authors: Christine Chien, Georgina Cheng
Journal: Journal of Clinical Oncology (2022)

347 Objectives: We performed a quality improvement project to evaluate the trends and safety of same-day discharge after minimally invasive hysterectomies at a community hospital during the COVID-19 pandemic and beyond. Background: The COVID-19 pandemic created an unprecedented demand on hospital resources as patients rapidly filled hospital beds. From March 16 to May 11, 2020, the Illinois Department of Public Health advised the cancellation of elective surgeries to reduce the burden on the health care system. Same-day discharge after hysterectomy has been trending since before the pandemic, but most research touting its safety describes its success among a select group of patients, generally young with few comorbidities, undergoing simple surgeries. We investigate how Carle Foundation Hospital (CFH) employed same-day discharge after hysterectomies during the pandemic. Methods: As a quality improvement project, we performed a retrospective review of patients who underwent hysterectomies at CFH before the start of the pandemic (November 2019 to February 2020) and afterwards (March to November 2020). Minimally invasive hysterectomies performed using either laparoscopic or robotic approaches were considered. Both benign and oncological cases were included. Same-day discharge was defined as no overnight stay after surgery. Patients discharged day of surgery were compared to those with overnight stays. Patient risk factors analyzed included age, race, body mass index (BMI), ASA score, malignancy, length of operation, estimated blood loss, zip code, and post-operative pain scores. Our primary outcomes were complications, ED visits, and readmissions within 30 days of surgery. Multivariate logistic regression was used to identify factors associated with negative outcomes. Results: From November 2019 to November 2020, 353 patients received minimally invasive hysterectomies at CFH. 294 (72.8%) hysterectomies were performed robotically. Rates of same-day discharge remained at 51% before and during the COVID-19 pandemic. Robotic hysterectomies were more likely to be discharged same day than laparoscopic (54% vs. 36%). Longer procedure time and living further from the hospital were significant predictors of overnight admissions, whereas age, BMI, ASA score, and post-operative pain were not. The rates of complications, ED visits, and readmissions did not significantly increase during this timeframe, nor was same-day discharge associated with a greater risk of negative outcomes overall. Conclusions: Our findings suggest that same-day discharge is safe after minimally invasive hysterectomies for patients who are average risk or below. Furthermore, the implementation of a carefully designed intervention at CFH may be able to safely raise rates of same-day discharge and conserve hospital resources.
Changes in cancer mortality rates after Medicaid expansion under the Affordable Care Act and the role of changes in stage at diagnosis.
Authors: Justin Michael Barnes, Kimberly J. Johnson, Nosayaba Osazuwa-Peters, Fumiko Chino
Journal: Journal of Clinical Oncology (2022)

74 Background: Medicaid expansion is associated with earlier cancer diagnoses and improved cancer survival. However, it is unclear if the expansion-associated survival benefits are driven primarily by early detection leading to improved prognosis and/or increased access to appropriate cancer care. A nationwide analysis was performed to determine the degree to which expansion-associated changes in cancer mortality rates can be explained by changes in stage at diagnosis. Methods: State-level cancer incidence and mortality data from 2001-2019 for individuals ages 20-64 years were obtained from the combined Surveillance, Epidemiology, and End Results and National Program of Cancer Registries databases (incidence) and the National Center for Health Statistics (mortality), which cover the 50 US States and Washington DC. Difference-in-differences analyses were conducted to compare changes in localized and distant stage cancer incidence rates and cancer mortality rates from pre- vs. post-2014 in expansion vs. non-expansion states. We utilized generalized estimating equations to account for autocorrelation within states and adjusted for age, race, sex, year, state, early Medicaid expansion effects, and state-level covariates (unemployment, education, poverty, race/ethnicity, and insurance). Analyses were conducted overall and by cancer site subtype. Mediation analyses were utilized to assess whether local and/or distant stage diagnosis rates were mediators of the changes in cancer mortality rates. Results: The data consisted of 16,470 state-year observations stratified by age, sex and race. In our adjusted analyses with all cancer sites combined, there were decreases in the distant stage cancer incidence rate (OR: 0.966, 95% CI = 0.942 - 0.991, P=.009) and cancer mortality rate (OR: 0.974, 95% CI = 0.950 - 0.999, P=.041) after Medicaid expansion in expansion relative to non-expansion states. There were no expansion-associated changes in localized cancer incidence rates (OR: 0.989, P=.45). Changes in distant stage cancer incidence mediated 26% of the expansion-associated change in cancer mortality ( P=.013). By cancer site, there were Medicaid expansion-associated decreases in cancer mortality rates for breast (OR: 0.954, P&lt;.001), cervical (OR: 0.934, P=.020), and colorectal (OR: 0.945, P=.045) cancers, though local or distant stage incidence rates were not found to be statistically significant mediators. Conclusions: Medicaid expansion was associated with decreased metastatic stage cancer incidence and decreased overall cancer mortality. Approximately 25% of the improvements in cancer mortality can be attributed to decreases in metastatic diagnoses suggesting increased rates of curative-intent treatment, amongst other factors. Remaining survival benefits may reflect access to timely, quality cancer care not captured in this analysis.
Evaluation of a virtual, nurse practitioner–led, pre-counselling seminar for mainstream germline genetic testing using a patient-reported outcomes measure (PROM).
Authors: Jennifer Marie Rauw, Laurie Barnhardt, Heather Lockyer
Journal: Journal of Clinical Oncology (2022)

290 Background: Ovarian cancer (OC) is a common, often fatal disease where 1/4 of cases are due to hereditary syndromes. Genetic screening of OC patients provides access to targeted treatments and screening recommendations. Patients are currently referred to a virtual, group, pre-counseling seminar, delivered by a Nurse Practitioner, where consent for germline genetic testing is obtained and results are delivered later by a Genetic Counsellor (GC). Previously, we found group pre-counseling to be an effective method to decrease wait times from diagnosis to test results. The purpose of this study was to evaluate the patient seminar experience using the previously validated, Genetic Counselling Outcome Scale (GCOS-24). BC Cancer- Victoria is a satellite of BC Cancer, providing tertiary cancer care to a population of ̃1.2 million. Methods: We completed a REB approved, prospective study recruiting patients referred to the group pre-counseling consenting seminar. The GCOS-24 was delivered electronically both pre (1) and post (2) attendance at the seminar, and 4 weeks post genetic counselling visit (3). Inclusion criteria included OC patients referred for germline BRCA testing between Jan 1, 2021, to Feb 28, 2022, &gt; 18 years old who attended the group consenting seminar. Patients who could not communicate in English were excluded. Data was stored electronically via REDCap, a secure web-based platform. Results: Thirty-eight patients attended the seminar and 28 consented to participate and completed the first questionnaire. Twenty-five patients completed the second questionnaire and 21 completed the third. The average age was 67, with 80% high grade serous, 11% low grade, 6% clear cell and 3% endometrioid OC subtypes. Forty- nine percent of participants were from Victoria area, and 11% were 225+ km away. The average GCOS-24 score for pre seminar participants was 111, post seminar 121 and post GC’s appointment 124. Twelve (52%) patients scored minimum clinically important difference (MCID) increase between questionnaires 1 and 2, and 14 (67%) patients scored MCID increase between questionnaires 1 and 3. The questions reflecting the most improvement in average scores between questionnaires 1 and 3 were exploring knowledge and emotions. Conclusions: Virtual group pre-counseling sessions for OC patients are feasible and allow germline genetic testing access to a geographically diverse group of eligible patients. Mean GCO-24 score almost reached MCID between pre seminar and post seminar visit and did reach MCID between pre counselling and post GC visit. There was a general trend to improved scores as patients moved from counselling naïve to pre-counseling to completed GC appointment. Virtual pre-counseling seminars should be considered as high impact, resource light method of improving access to germline genetic counselling for OC patients.
Capture of common adverse events (AEs) by patient-reported outcome measures (PROMs) used in clinical trials of immuno-oncology (IO)-based combination therapies in advanced renal cell carcinoma (aRCC).
Authors: Stephen Huo, Flavia Ejzykowicz, Andrew Delgado, Karen D. Beauchamp
Journal: Journal of Clinical Oncology (2022)

263 Background: IO-based combination therapies have improved clinical outcomes in aRCC; several are approved for first-line use. AEs can significantly impact quality of life, and IO therapy is associated with AEs that differ from prior standard treatment toxicities. PROMs capture health status directly from patients and often include the symptoms and severity of AEs. Our aim was to assess the extent to which the PROMs used in pivotal trials covered the most common AEs associated with IO combinations. Methods: This was a review of data from four phase 3, randomized, open-label studies of IO-based combinations in previously untreated advanced/metastatic clear-cell RCC (CheckMate 214, CheckMate 9ER, KEYNOTE-426, CLEAR [KEYNOTE-581]). The 10 most common all-grade, all-cause AEs (%) and the PROMs used in each trial were identified. The inclusion of the most common AEs in the PROMs was explored descriptively. Results: The most common AEs and their frequencies varied among the different combination regimens. There was also variation across trials in the PROMs used. Capture of the most common AEs by the PROMs used in each study is summarized in the Table. Conclusions: Current PROMs used in clinical trials of IO combinations for aRCC tend to capture more of the common AEs for IO-IO vs IO-tyrosine kinase inhibitor regimens. PROMs that reflect the unique AE profiles of IO therapies, especially from the patient perspective, may be needed for future trials.[Table: see text]
Supportive oncology care at home after discharge for patients with advanced cancer.
Authors: Daniel E Lage, Patrick Connor Johnson, Shira Hornstein, Isabel Neckermann, Alane Schmelkin, Connor Grayzel, Patricia Brown, Meghan McGrath, Eliza Shulman, Melissa Smith, Ryan David Nipp, Areej El-Jawahri
Journal: Journal of Clinical Oncology (2022)

295 Background: Patients with advanced cancer often experience frequent and prolonged hospitalizations, and the transition from hospital to home represents a critical period for these individuals, as they prefer to maximize time at home and avoid readmissions. We sought to demonstrate the feasibility and acceptability of a Supportive Oncology Care at Home intervention to address the post-discharge needs of recently hospitalized patients with advanced cancer. Methods: We conducted a single-arm pilot trial at Massachusetts General Hospital (MGH). We enrolled English-speaking adults with advanced solid tumors experiencing their second or later unplanned hospitalization, who were being discharged home without hospice services and residing within a 50 mile radius of MGH. The three-week intervention consisted of: 1) hospital in the home care model for proactive symptom assessment and management, including clinician visits to assess patients, draw labs, administer intravenous medications and hydration, and ensure optimal symptom management; 2) remote monitoring of daily patient-reported symptoms, vital signs, and body weight; and 3) structured communication with the oncology team. The primary endpoint of the study was feasibility, defined as ≥60% of approached and eligible patients enrolling and ≥60% of participants completing daily symptom assessments. After intervention completion, patients rated the helpfulness and convenience of the intervention and symptom monitoring technology. Results: From 12/2021-6/2022, we enrolled 40 out of 66 approached patients (60.6% enrollment rate). Enrolled patients (median age = 58.5 years, 50% female, 75% white, 68% married, 50% gastrointestinal cancers) completed 93.8% of daily symptom assessments. 12 patients (30%) did not complete the intervention due to withdrawal (5), hospice transfer (4), or death (3). Among enrolled patients, 20.0% were enrolled in hospice and 15.4% died at 30 days after hospital discharge. In exit interviews, 100% and 75% rated the intervention and symptom monitoring as helpful, respectively. 83% of patients found the in-home monitoring technology convenient. Conclusions: We found that a three-week Supportive Oncology Care at Home intervention is a feasible approach to providing post-discharge care for high acuity, seriously ill hospitalized patients with advanced cancer. These patients also found the intervention highly acceptable. Future studies will test the efficacy of the intervention for reducing hospital readmissions, improving symptom management and quality of life, and increasing days spent at home near the end of life. Clinical trial information: NCT04637035.
Fostering a high-functioning team in cancer care using the 4R Oncology model: Assessment in a large health system.
Authors: Raymond Liu, Christine B. Weldon, Elizabeth Shurell Linehan, Nancy P. Gordon, Thea Abbe, Marti Hennings, Henie James, Jed Abraham Katzel, Chun Fai Ng, Megumi Tomita, Jeffrey B. Velotta, Stephanie Ossowski, Lori C. Sakoda, Sharon Sprague, Anna Dowling, Kimberly Beringer, Arliene Ravelo, Elaine Yu, Julia R. Trosman
Journal: Journal of Clinical Oncology (2022)

57 Background: Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation and complexity, which threaten care quality, impact patient outcomes, and strain the oncology workforce. We assessed whether the 4R Oncology model (Trosman et al 2021) for team-based interdependent care delivery and patient self-management impacted team functioning at Kaiser Permanente Northern California (KPNC), a large community-based health system. Methods: We deployed the 4R intervention in breast and lung cancers at 4 KPNC centers. The intervention encompassed team development and care delivery optimizations enabling teamwork. 4R Care Sequences – novel patient-facing care plans outlining timing and sequence of care – informed team formation, activities and functioning. We assessed intervention along 4 characteristics of high-functioning teams (Vogel JOP 2016). Results: 4R facilitated development of a high-functioning team along all 4 characteristics. (1) We formed an internally and externally recognized multidisciplinary team of 24 specialties who assumed team responsibilities for relevant care. (2) All participants committed to a shared goal of delivering interdependent care at the optimal time and sequence based on Care Sequences. (3) The team conducted 40 optimizations to enable effective interdependent care: 22 in breast, 7 in lung, and 11 in both cancers (Table). The optimizations impacted 6 care domains at 4 points in care continuum. Half of optimizations entailed low effort; 70% resulted in improved process efficiency. (4) An ongoing teamwork adaptation process was established. Conclusions: 4R is an effective and feasible approach to fostering high-functioning teams, which may contribute to improvement of multidisciplinary care delivery and support viability of the oncology workforce. Our intervention and taxonomy of results inform other institutions motivated to strengthen teamwork and improve delivery of complex interdependent care.[Table: see text]
Nationwide implementation of a multifaceted, tailored strategy to improve uptake of standardized structured reporting in oncological pathology: An effect and process evaluation.
Authors: Julie Swillens, Quirinus Voorham, Reinier P. Akkermans, Iris D. Nagtegaal, Rosella Hermens
Journal: Journal of Clinical Oncology (2022)

336 Background: Implementation strategies improve guideline adherence. Effect and process evaluations are conducted to provide insights into success or failure of implementation strategies. We conducted both evaluations to determine nationwide implementation of standardized structured reporting (SSR) in pathology, to facilitate optimal treatment decisions in oncology care. Methods: We conducted an interrupted time series analysis to evaluate the effect of a fully digital nationwide implementation strategy on SSR use in pathology laboratories. We further conducted a process evaluation to evaluate the exposure to the strategy elements, the experiences of the users with the implementation strategy and remaining barriers of SSR implementation. We also tested whether being exposed to a specific element of the strategy resulted in more increase of average SSR use. Results: There was a significant increase in average SSR use directly after the strategy introduction for reporting of gastrointestinal ( p =.018) and urological ( p =.003) oncological diagnoses. A significant increase was present for all oncological resections as a group ( p =.007). The “Feedback button”, an option within the templates used for standardized structured reporting to provide feedback to the provider and one of the elements of the implementation strategy, was most frequently used by the SSR users and effectiveness results showed that it increased average SSR use after strategy introduction. Remaining barriers most related to rigidity, time consumption and content of SSR. Conclusions: Nationwide SSR implementation improved for specific tumor types and retrieval methods. Next step will be to further improve the use of SSR, and simultaneously, to further develop potential benefits of high SSR use, focusing on re-using discrete pathology data. In this way, we can eventually facilitate proper treatment decisions in oncology.